Stage 4 Renal Cell Carcinoma: Treatment and Prognosis

What Is Renal Cell Carcinoma?

What Is Renal Cell Carcinoma?

Renal
cell carcinoma (RCC) is a type of cancer that affects the cells of the kidney.
Among all types of kidney cancer, RCC is the most common. There are several
risk factors for developing RCC, including: a family history, smoking, and
having polycystic kidney disease. As with all types of cancer, the earlier it’s
detected, the greater your chance for effective treatment.

Click through the slideshow to learn about
this type of cancer.

RCC Staging

RCC Staging

Doctors who diagnose and treat RCC and other types of
cancer use a staging system. Each patient’s cancer is given a number designation
ranging from one to four. Stage 1 is the earliest stage of the disease, and 4
is the latest and most advanced.

Staging
for RCC is based on:

the size of the primary tumor in the kidney

the spread of cancerous cells from the primary
tumor to nearby tissues

the degree of metastasis

the spread of the cancer to other organs in
the body

Stage 4 RCC

Stage 4 RCC

Stage 4 RCC can include two different combinations of
staging criteria. The first is when the primary tumor is large and has spread
throughout the kidney and into nearby tissues. In this instance, the cancer
cells may or may not have spread into other organs in the body.

The other possibility for classifying RCC as stage 4 is
when the cancer has metastasized and is present in distant organs. In this
case, the primary tumor may be of any size and there may or may not be any
cancer in the tissues immediately surrounding the kidney.

Surgery

Surgery

Although stage 4 RCC is classified as an advanced stage
of cancer, there are still treatment options available, including surgery.

A radical
nephrectomy may be performed. This involves moving most or all of a kidney.
Surgical removal of other tumors may be needed for patients with metastatic
cancer.

A team of specialists will decide whether the
metastasized tumors can be removed without too much risk to the patient.

Systemic Therapy

Systemic Therapy

Surgery to remove tumors is considered local therapy. It targets cancer in
specific locations only. Once surgery has been performed to remove local
tumors, many patients may need systemic
therapy, which treats cancer throughout the body. This can help to reduce cancer
recurrences. Systemic therapy for stage 4 RCC includes immunotherapy, targeted
therapy, and chemotherapy.

Immunotherapy

Immunotherapy

Immunotherapy is a treatment technique that aims to
stimulate the immune system to attack cancer cells. Not everyone with RCC
responds well to immunotherapy and side effects can be serious. Only about 15
percent of patients see anti-cancer effects from immune-boosting
drug treatment.

Despite the low numbers, the treatment does help some
people, and it proves promising enough that researchers continue to develop new
immune-therapies.

Targeted Therapy

Targeted Therapy

Targeted therapy for RCC means using drugs that
specifically target cancer cells. Targeted drugs are desirable because they do
not harm or kill healthy cells in the body. There are several targeted
medications for stage 4 RCC.

They work by targeting a protein called vascular
endothelial growth factor, which stimulates the growth of cancer cells. The
development of these targeted drugs has helped extend the lives of stage 4
patients by a year or more.

Chemotherapy

Chemotherapy

Chemotherapy is a traditional treatment method for
several different types of cancers. It involves using a drug or combination of
drugs to kill cancer cells. Chemotherapy drugs are not targeted, however, so
they kill healthy cells as well and produce a lot of side effects. RCC
generally resists chemotherapy, but some patients do benefit from this type of
treatment.

Clinical Trials

Clinical Trials

Another option for patients with stage 4 RCC is to become
involved in clinical trials. Clinical trials are research trials for testing
new drugs and treatments, which may be risky.

The survival rate for patients with stage 4 cancer is
low, so entry into these trials is usually possible. Patients can discuss
current clinical trials with their doctors or specialists.

Palliative Care

Palliative Care

If all treatment options have been exhausted and have been
ineffective, or if the patient is ineligible for treatment, palliative care may
be initiated. This involves making sure the patient is as comfortable and as
pain-free as possible.

If surgery is not possible for a stage 4 RCC, tumor embolization may be used. This
procedure cuts off the blood supply to the kidney tumor, which helps to reduce
symptoms.

Outlook for Stage 4 Patients

Outlook for Stage 4 Patients

The five-year survival rate for all stage 4 RCC patients
is eight percent. However, different scenarios may result in higher survival
rates. Patients who are able to have surgery to remove metastatic tumors have
better survival rates, and many who are treated with targeted drugs survive
longer.

Dialysis is an artificial method of filtering the blood and is used when someone's kidneys have failed or are close to failing. Many people with late-stage kidney disease must go on dialysis either permanently or until a donor kidney for transplantation can be found.

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